CLINICAL STUDY DEMONSTRATING ESCHAR DEBRIDEMENT AND WOUND HEALING IN A BACTERIOSTATIC ENVIRONMENT UTILIZING A HYDROGEL SHEET

Clinicians: Ruth Anderson, RN, CWS and Char Wilkening, RN, CWS

Boone County Hospital, Boone, IA

ABSTRACT

This case study demonstrates the use of a special glycerine sheet dressing that assists in the healing process and reduces the chance of infection in a heel ulcer. Although a number of posters have been presented on the effectiveness of the glycerine sheet dressing for prevention and management of pressure ulcers, the question of the how to manage eschar covered heel ulcers persists. We routinely manage these wounds by covering them with the bacteriostatic/fungistatic glycerine dressing. This dressing is simple to use and we have found that it has always prevented infection in these wounds. This poster demonstrates the result that is typically observed with this dressing even with patients with highly compromised immune systems.

A frail elderly patient with chronic obstructive pulmonary disease and diabetes, who resides at a nursing home, presented at wound clinic with an eschar covered heel. The area measured 4.0 cm width x 3.1 cm length and was covered with black eschar. Initial treatment was cleansing of the area and covering with a glycerine based hydrogel sheet. The nursing home was instructed to change the dressing twice weekly and as needed. The peri wound skin was moisturized twice daily.

At two weeks the wound measured 2.0 cm width x 2.0 cm length. At this time the dressing had dehydrated the eschar so that easy removal was accomplished revealing active fibroblasts throughout the stage III wound bed. Based on the healthy wound bed and previous experience, the treatment plan remained unchanged.

Healing continued at each clinic visit as noted by the smaller size of the wound and the clean healthy wound bed. The wound was healed in sixty-four days with no signs or symptoms of infection throughout the whole healing process.

The hydrogel sheet provided a bacteriostatic environment and absorption of wound fluid causing dehydration of the eschar. Other benefits of using this dressing included its cushioning effect, quick efficient dressing changes, and reduced nursing time. In addition, the high glycerine content kept the eschar pliable, which allowed wound healing and reduction of wound size even with the eschar intact. It also made the removal of the eschar a simple one step process when the time to do so occurred. These factors made this a simple and effective treatment for healing this wound.

Presented at the 18th Annual Clinical Symposium on Skin and Wound Care

October 16-18, 2003

Chicago, IL

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